FAST MRI Research Team

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The FAST MRI Programme has been developed by a multidisciplinary team of collaborating clinicians, academics and members of the public across the UK, led by North Bristol NHS Trust. Together the FAST MRI team bring a wealth of experience in imaging, research, science and breast cancer screening and treatment.

FAST MRI Logo

Early breast cancer detection and diagnosis saves lives. The NHS Breast Screening Programme offers women aged 50-70 years a mammogram every 3 years. By detecting breast cancers before they can be seen or felt, breast screening already saves about 1,300 lives each year in the UK. MRI scans can detect some aggressive breast cancers even earlier than mammograms.

Unfortunately, MRI scans are expensive, and so the NHS uses them only to screen women at a high risk of developing breast cancer. New evidence suggests that MRI scans can be abbreviated to reduce their cost to the NHS, without affecting their ability to accurately display breast cancers.

FAST MRI is an abbreviated form of MRI which takes less time to acquire (3 vs 20 mins on the scanner) and to interpret (1 vs 10 mins). Unlike mammograms, FAST MRI scans can identify aggressive cancers irrespective of breast density – a trait found more commonly in younger women. Therefore, we are developing FAST MRI for women who are having their first screening by the NHS Breast Screening Programme. We wish to find out if FAST MRI could find aggressive cancers even earlier and smaller for these women because early detection of breast cancer saves lives.

Meet the team:

Dr Lyn Jones

Consultant Radiologist - FAST MRI Programme Lead

Dr Lyn Jones is a Consultant Radiologist specialising in Breast Care. Lyn was struck by the potential for FAST MRI to pick up aggressive breast cancers earlier for women, regardless of their mammographic density, and so she set up the FAST MRI Programme of Research at North Bristol NHS Trust. She became Chief Investigator for local and National Institute for Health and Care Research (NIHR), Research for Patient Benefit (RfPB) grants, designing and testing a training programme for NHS Breast Screening Programme (NHSBSP) mammogram readers to learn to interpret FAST MRI.

Lyn leads the FAST MRI Programme of Research and is currently Chief Investigator for the FAST MRI DYAMOND Study, funded jointly by the Medical Research Council (MRC) and the NIHR, through a grant from their Efficacy and Mechanism Evaluation (EME) funding stream. The study will be the first in the UK to offer a FAST MRI to women who have average mammographic density and are having their first NHS screening mammogram.

Lyn lectures nationally and internationally on breast MRI and has written sessions on breast MRI for the National Breast Imaging Academy.

Dr Becky Geach

Consultant Radiologist

Dr Geach is a Consultant Radiologist and the Radiology Research Lead at North Bristol NHS Trust. Becky has been part of the FAST MRI Programme for nearly five years previously co-leading on the FAST MRI reader training. She is now a co-lead for the EME NIHR funded grant FAST MRI DYAMOND study which started in May 2023.

Becky has also presented at a number of national conferences including a poster on “Abbreviated Breast MRI – A systematic review” which was awarded third prize in the scientific poster category at the British Society of Breast Radiology Annual Meeting. She is the lead author of the FAST MRI Team’s systematic review and meta-analysis of abbreviated breast MRI, published in Clinical Radiology in 2021.

Dr Katherine Klimczak

Consultant Radiologist

Katherine graduated from the University of Wales in 2008 and worked in Swansea before crossing the border to undertake Radiology training in the Severn Deanery.  She has been a Consultant Breast Radiologist at North Bristol NHS Trust since 2018 and has been a contributing member of the FAST MRI Research Programme since 2020.  Katherine is currently the Chief Investigator for the FAST MRI ENAID project and FAST MRI OPERA study.

Sadie Mckeown-Keegan

FAST MRI Programme Manager

Sadie is the FAST MRI Programme Manager. Sadie co-ordinates the grants, approvals, contracts and site set up for new studies and general management of the studies in progress to maintain oversight of the study, ensuring they run to time, target and protocol.

Dr Sam Harding

Senior Research Fellow

Dr Sam Harding is a Senior Research Fellow at North Bristol NHS Trust. She is a Health Psychologist and PhD. Sam is a mixed methodologist researcher with additional expertise in scoping and systematic reviews.  Her research portfolio covers a diverse set of medical fields from Hyperbaric Medicine, Speech and Language Therapy and Head and Neck cancer, to working with the FAST MRI team. Sam’s interests lay in quality of life and the impact of medical interventions on chronic conditions. She also investigates lived experiences in relation to treatments, interventions and education. Sam has worked on a number of FAST MRI projects including qualitative research, supporting Public & Patient Involvement.

Professor Janet Dunn

Cancer Trials Lead, Warwick Clinical Trials Unit

Professor Janet Dunn is the Deputy Director of Warwick Clinical Trials Unit (CTU) at Warwick Medical School, University of Warwick. She has over 25 years clinical trials experience. Janet has been instrumental in supporting the set up of the FAST MRI programme and the running of the studies with wide knowledge.

Dr Andrea Marshall

Associate Professor, Warwick Clinical Trials Unit

Dr Andrea Marshall is an Associate Professor at Warwick Clinical Trials Unit (CTU) at Warwick Medical School, University of Warwick. Specialising in statistical design and analysis of randomised clinical trials Andrea has led all the quantitative analysis for the FAST MRI studies.

Professor Sian Taylor-Phillips

Professor of Screening & Test Evaluation

Professor Sian Taylor-Phillips leads Warwick Screening at Warwick Medical School, University of Warwick. Sian has brought a wealth of screening experience to the FAST MRI programme, her research focuses on synthesising evidence for national policy advisers such as the UK National Screening Committee and NICE.

Dr Sarah Vinnicombe

Consultant Radiologist

Dr Sarah Vinnicombe is currently Lead Breast Radiologist, Deputy Director of Screening and Consultant Radiologist at the Thirlestaine Breast Centre, Cheltenham. Until 2011, she was lead Breast Radiologist and Director of Breast Screening at Barts Health, when she moved to the University of Dundee to take up a Senior Lectureship in Cancer Imaging, a post she held till 2018.

In Cheltenham, she leads on breast imaging research and is PI and co-investigator on a number of national and local studies. Her main research interests are in breast density, risk adapted screening, imaging of response to neoadjuvant therapy and novel breast imaging techniques. She sits on the NHS BSP Research Advisory Committee and is a member of the NHS BSP Clinical Professional Group, advising on all radiological aspects of the Breast Screening Programme.

She is a Trustee of Symposium Mammographicum and Vice Chair of the Organising Committee and has been President of the British Society of Breast Radiology since November 2019.

Dr Chris Foy

Statistician & Methodologist, Research Design Service

Chris is a statistician and methodologist for the Research Design Service of the NIHR. Chris has worked with Lyn from the start, from when it was all just an idea. With Chris’s expertise in statistics, clinical trials, research ethics and health economics he has supported Lyn to set up the FAST MRI programme and continues to be a valued advisor.

Professor Claire Hulme

Professor of Health Economics

Professor Claire Hulme is a Professor of Health Economics, Director of the Institute of Health Research at the University of Exeter. Claire has been invaluable, supporting the FAST MRI Programme with reviews of the cost and cost effectiveness of imaging and Budget Impact Analysis. Claire was also invited to present her abstract “Estimating the cost impact of including Magnetic Resonance Imaging (MRI) in the National Health Service Breast Screening Programme (NHSBSP) for population-risk women in England” at the Symposium Mammographicum in February 2021.

Professor Mark Halling-Brown

Head of Scientific Computing

Professor Mark Halling Brown is the Head of Scientific Computing at Royal Surrey County Hospital. He leads a team in the development of Clinical Systems and databases, services and techniques for visualization, analysis and investigation of medical imagery, improvement of QA services, clinical applications and AI/Machine learning on medical images.

His team has developed the OPTIMAM project has led to the creation of one of the world’s largest mammography image databases (OMI-DB). Our recent focus involves the development and validation of AI tools for use in healthcare.

Dr Elizabeth O’Flynn

Consultant Breast Radiologist

Dr Elizabeth O’Flynn is a Consultant Breast Radiologist at St George’s Hospital in London. Dr O’Flynn completed an MD thesis in breast imaging while at the Institute of Cancer Research and Royal Marsden Hospital. She has published on breast related topics, has a book chapter on functional breast imaging techniques and lectures nationally and internationally on all aspects of breast imaging.

Miss Shelley Potter

NIHR Clinician Scientist

Miss Shelley Potter is an NIHR Clinician Scientist, Associate Professor of Oncoplastic Breast Surgery and Consultant Oncoplastic Breast Surgeon, dividing her time between the University and the Bristol Breast Care Centre at North Bristol NHS Trust.

Shelley’s research interest include using pilot and feasibility work to inform the design and conduct of large-scale RCTs in breast surgery. She co-led the NIHR funded iBRA (Implant Breast Reconstruction evAluation) study which aimed to inform the feasibility, design and conduct of an RCT in implant-based breast reconstruction and is now leading Best-BRA, an implant reconstruction RCT. 

Shelley will be supporting the FAST MRI study with her expertise on cancer treatments and outcomes.

The BIRCH team

The BIRCH team provides scientific and technical support to a wide range of services within UHBW, external NHS Trusts, NHS screening programmes and other institutions in the region. We have expertise in Magnetic Resonance Imaging (MRI), ultrasound (US) and scientific computing (image processing). Our key services in MRI cover procurement, acceptance and quality assurance (QA) testing, MR safety expert advice, image optimisation and adoption of new techniques. We have also developed in-house phantoms and software for semi-automated MRI QA image analysis.

Personnel involved:

  • Dr Sian Curtis (PhD) is a registered Principal Clinical Scientist specialising in MRI and ultrasound and has worked at UHBW for over 20 years. She is a corresponding member (and previous Chair) of the Institute of Physics and Engineering in Medicine’s Magnetic Resonance Special Interest Group (IPEM MR SIG), a British Medical Ultrasound Society (BMUS) council member and the BMUS representative on the IPEM Ultrasound and Non-Ionising Radiation SIG (IPEM UNIR SIG).
  • Mr Ron Hartley-Davies is a registered Principal Clinical Scientist specialising in MRI and scientific computing and has worked at UHBW for over 20 years. He is the designated MR Safety Expert (MRSE) for UHBW.
  • Mr Jonathon Delve is a registered Clinical Scientist specialising in MRI and scientific computing.
  • Dr Holly Elbert (PhD) is a registered Clinical Scientist specialising in MRI, ultrasound and scientific computing. She did a DPhil in Astrophysics before training in Medical Physics at UHBW from 2016-2019. During her training she did projects in phantom construction and functional MRI analysis, and a placement at the Cardiff University Brain Research Imaging Centre on diffusion MRI analysis.

Public Involvement Members

The FAST MRI programme includes several Public and Patient Involvement representatives. They sit on the Trial Steering Committee giving input into the conduct of the study progress of the trial/project, adherence to the protocol, and the consideration of new information of relevance to the research question. They comment on the rights, safety and well-being of participants and proposals for substantial protocol amendments and provide advice to the sponsor and funder regarding approvals of such amendments.

Their membership is invaluable as they are able to ensure that patients are at the centre of the research conducted as part of the FAST MRI programme; reviewing documentation to make sure that it is written in lay language and that results from the studies are disseminated to the general public.

Public Representatives:

  • Jenny Wookey is the Chair of BUST (North Bristol Trust’s Breast Cancer Unit Support Trust).
  • Jan Rose is a member of the ICPV (Independent Cancer Patient’s Voice) and National Cancer Research Institute Breast Group.
  • Helen Matthews works for the civil service in educational policy. She was diagnosed with high grade ductal carcinoma in situ (DCIS) in November 2021 following a routine screening mammogram, underwent treatment and is now continuing to lead a healthy and active life. She has joined the team to encourage the expansion and effectiveness of routine testing, knowing that it has saved her life.

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Dietary advice for avoiding lactose

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What is lactose intolerance?

Lactose intolerance means that your body cannot digest lactose. Milk is made up of fats, proteins and sugar (carbohydrate). Lactose is a type of sugar (carbohydrate) that is in milk and milk products.

What are the symptoms?

  • Wind 
  • Bloating
  • Tummy ache
  • Stomach cramps
  • Tummy rumbling
  • Nausea (feeling sick)
  • Diarrhoea (loose stools)

What are the causes?

Lactose intolerance happens when your body does not make enough lactase.

Lactase is an enzyme that breaks down lactose; it is made in the lining of the small bowel. Enzymes break down sugars into smaller parts, so that they can pass from your gut into your body.

Types of lactose intolerance

There are two types of lactose intolerance: primary and secondary.

Primary lactase deficiency

Primary lactase deficiency is a lifelong genetic condition (runs in families). It is most common in people from Africa and Asia, but anyone can have it. 2 out of 3 people in the world have this. You may produce lactase as a child, but less lactase as you grow up.

Secondary lactase deficiency

Secondary lactase deficiency is usually short term. It is due to illnesses that affect your small bowel such as coeliac disease, inflammatory bowel disease (IBD), gastrointestinal infections and abdominal surgery.
Lactose cannot be broken down or absorbed without lactase. It will pass into the colon instead. In the colon it will be fermented which makes gas. Lactose also pulls water into the bowel, which is why it can also cause loose stools.

Lactose intolerance is not the same as an allergy. If you have lactose intolerance you may be able to manage some lactose in your diet in smaller amounts. However, if you have a milk protein allergy you need to strictly avoid all milk products.

Some people do not make the lactase enzyme but do not get bad symptoms. Other people can make the lactase enzyme but still have bad symptoms. Lactose may make you feel ill but it will not do any long-term harm or hurt your body. You need to work out how much lactose is right for you and your symptoms.

Diagnosis

Hydrogen Breath Test

In this test, you drink a special high lactose drink and they test how much hydrogen gas is in your breath. If your body does not break the lactose down, the bacteria that live in your colon will ferment it. This makes lots of hydrogen gas, so a high level of hydrogen in your breath means you have lactose intolerance.

The test results are not perfect. Some people have a positive breath test but no symptoms. Some people have a negative breath test but still have symptoms. Sometimes a lactose free trial is better.

Lactose free trial

This is a good choice instead of the breath test.

Stop having lactose for a short time (about 2-4 weeks). If you do not feel better, then you do not have lactose intolerance and you can start having lactose again. You can talk to your doctor or dietitian about what else could help your symptoms.

Which foods contain lactose?

Lactose is in milk, including breastmilk, cow’s milk, sheep’s milk and goat’s milk. All products containing milk or made from milk contain lactose.

Everyone will tolerate a different amount of lactose. Most people can have a low lactose diet, but some people will need to be stricter. For example, you might be able to have a splash of milk in tea, but you might have symptoms if you had a milky coffee.

  • Start by strictly avoiding lactose.
  • If your symptoms get better, you can slowly increase your lactose intake.
  • Most people can have some lactose. Try to spread it out through the day.

The information below shows how much lactose is in different foods.

The amount of lactose in some foods can vary. There is not an exact amount of lactose in the table for these foods, but you can see which foods are lactose free, low in lactose or high in lactose.

Food groups

If you would like a printed copy of this information in a table format, please speak to your clinician.

Milk

High lactose (more than 2g /100g)

  • Cow’s milk: 4.6 - 4.8g /100g
  • Sheep’s milk: 5.1g /100g
  • Goat’s milk: 4.4g /100g
  • Condensed milk: 12.3g /100g
  • Evaporated milk: 12.7g /100g
  • Dried milk powder: 52.9g /100g
  • Cream alternative (Elmlea): 4g /100g

Low lactose (up to 2g /100g)

  • Creme Fraiche: 2g /100g
  • Cream: 1.7 - 2.2g /100g
  • Soured cream

Lactose free

  • Oat milk
  • Rice milk
  • Soya milk
  • Coconut milk
  • Hazelnut milk
  • Almond milk
  • Tiger nut milk
  • Lactose free milk
  • Hemp milk

Other dairy

High lactose (more than 2g /100g)

  • Yoghurts: 3.6 - 4.7g /100g
  • Lassi: 8.6g /100g
  • Fromage frais: 2.9 - 4.1g /100g
  • Custard: 4.6 - 5.4g /100g
  • Rice pudding: 3.9 - 4.9g /100g
  • Mousse: 5.7g /100g

Low lactose (up to 2g /100g)

  • Cheesecake

Lactose free

  • Soya desserts / dairy free yoghurt style
  • Lactose free yoghurts

Cheese

High lactose (more than 2g /100g)

  • Cottage cheese: 3.5g /100g
  • Processed cheese: 6.5g /100g
  • Cheese spread, e.g. Philadelphia or supermarket own versions
  • Ricotta
  • Mascarpone: 4.5g /100g

Low lactose (up to 2g /100g)

  • Hard cheese: 0.1g /100g
  • Blue cheese: 1.0g /100g
  • Ripe / rind cheeses: 0.9g /100g
  • Mozzarella: <0.1g /100g
  • Goat’s cheese: 0.9g /100g
  • Feta: 1.4g /100g
  • Halloumi: 1.5g /100g
  • Lactose free cheese: <0.1g /100g
  • Low / reduced fat cheese
  • Brie: <0.1g /100g
  • Cheddar: 0.1g /100g

Lactose free

  • Dairy free cheese alternative

Cereals

High lactose (more than 2g /100g)

  • Yoghurt coated cereal bars
  • Porridge made with milk

Lactose free

  • Breakfast cereals

Bread

Low lactose (up to 2g /100g)

  • Milk bread
  • Some gluten free bread contains milk

Lactose free

  • All other breads

Rice

High lactose (more than 2g /100g)

  • Rice pudding: 3.9 - 4.9g /100g

Low lactose (up to 2g /100g)

  • Risotto

Lactose free

  • Rice
  • Rice cakes
  • Sushi

Pasta

High lactose (more than 2g /100g)

  • Macaroni cheese
  • Ricotta ravioli
  • Lasagne

Lactose free

  • Pasta with tomato sauce
  • Check free from section for dairy free white sauce, macaroni cheese or lasagne

Treats/snacks

High lactose (more than 2g /100g)

  • Milk chocolate
  • White chocolate
  • Ice cream
  • Chocolate cake bars

Low lactose (up to 2g /100g)

  • Cheese and onion crisps
  • Cheesy puffs / corn snacks
  • Biscuits
  • Chocolate coated / dipped biscuits
  • Cake
  • Cheese crackers: <0.3g /100g
  • Fudge / toffee: <1.5g /100g
  • Pastry made with butter: 3.3g /100g

Lactose free

  • Most crisps
  • Sorbet
  • Dairy free ice cream
  • Jelly

Fats

Low lactose (up to 2g /100g)

  • Butter
  • Ghee
  • Reduced fat spreads
  • Margarine

Lactose free

  • Vegetable oils
  • Coconut oil
  • Lard
  • Dairy free spreads

Meat, fish, eggs and alternatives

High lactose (more than 2g /100g)

  • Omelette made with milk

Low lactose (up to 2g /100g)

  • Scrambled egg made with butter / milk
  • Battered fish (some does have milk in, some does not)

Lactose free

  • Meat
  • Fish
  • Eggs
  • Tofu
  • Quorn
  • Vegan meat alternatives

Sauces / condiments

High lactose (more than 2g /100g)

  • White sauce
  • Ready made custard

Lactose free

  • Jam
  • Marmite
  • Peanut butter
  • Mayonnaise (check as some brands contain milk or cream)
  • Ketchup
  • Vinegar
  • Custard powder
  • Gravy
  • Spices / herbs
  • Chutney / pickle

Fruit, veg, nuts, pulses

High lactose (more than 2g /100g)

  • Yoghurt coated dried fruit / nuts

Low lactose (up to 2g /100g)

  • Mashed potato made with butter / milk
  • Instant mash
  • Soup containing cream

Lactose free

  • All fruit and vegetables
  • Baked beans
  • Pulses
  • Chips, potato waffles, hash browns
  • Nuts

Checking labels

It is the law that if a product contains milk products they will be listed in bold, underlined, or highlighted.

The ingredients list is in weight order, with the largest first. If it is near the bottom of the list then there is a smaller amount in the food. If milk is one of the last ingredients in a long list, it might be fine.

Vegan foods are lactose-free.

Check labels for:

  • Milk
  • Milk solid
  • Skimmed milk powder
  • Cream
  • Butter
  • Buttermilk
  • Whey

“May contain”

Most people with lactose intolerance can have a food that says “may contain milk” or “made in a factory that handles milk” or “not suitable for people with a milk allergy”.

Confusing ingredients

Casein and milk protein are sometimes listed within the ingredients and are proteins found in milk; you can have both of these ingredients. Some people have an allergy to milk protein, but this is not the same as lactose intolerance.

Medications

Some tablets contain very small amounts of lactose. Do not worry unless you take lots of tablets.

You can talk to the pharmacist about changing to lactose free medicine. Do not stop taking a medication without speaking to your doctor or pharmacist first. Lactulose (a laxative) is not the same as lactose.

Nutrients

Dairy products provide some key nutrients. You need to make sure you get enough of these. Remember that most cheese is low in lactose so it may be okay for you.

Vitamin B12

You need vitamin B12 to help with energy release, healthy blood and the nervous system.

Non-dairy sources of vitamin B12:

  • meat
  • eggs
  • fortified breakfast cereal
  • yeast extract (marmite)
  • salmon
  • cod

Calcium

You need calcium for bone health. Milk and dairy products are the main sources of calcium.

  • Lactose-free milk contains the same amount of calcium as cow’s milk.
  • If you use a milk alternative (oat/soya/coconut/nut milk), make sure it has added calcium.
  • Organic milk alternatives do not have calcium added to them.
  • Tinned fish with bones (sardines, pilchards, salmon) are very high in calcium.
  • Oranges, almonds, brazil nuts and tofu also contain calcium but it is not so easily absorbed.

You may need to take a calcium tablet if your bone health is high risk such as:

  • Breastfeeding mothers
  • Post-menopausal women
  • Coeliac disease
  • Inflammatory bowel disease

Vitamin D

You need vitamin D to use calcium.

The body makes vitamin D from sunlight on your skin. In the UK there is not enough sunshine in autumn or winter to make all the vitamin D that we need.

Consider taking a vitamin D supplement daily in autumn and winter.

Vitamin D is in oily fish, red meat, offal, and egg yolks. Some breakfast cereals, margarines and non-dairy milk alternatives have vitamin D added.

Protein

You need protein for growth and repair, and to keep you strong.

Some lactose free milks have more protein than others. Lactose free cow’s milk and soya milk contain the most protein; oat and nut milks contain the least protein.

Eat 2 - 3 portions of high protein foods daily.

Non-dairy sources of protein include meat, fish, eggs, beans/pulses, tofu and nuts.

Meal ideas

Breakfast

  • Cereal with lactose free milk
  • Toast with dairy free spread and jam

Lunch

  • Sandwich with dairy free spread and tuna/ ham/ chicken/hard cheese and salad
  • Homemade soup made without milk or cream
  • Jacket potato with dairy free spread, tuna/baked beans/hard cheese and salad
  • Eggs or baked beans on toast with dairy free spread

Evening meal

  • Meat/chicken/fish with potatoes or rice and vegetables
  • Omelette/frittata with side salad
  • Spaghetti Bolognese
  • Curry made without yoghurt, with rice and dahl

Snacks

  • Fruit
  • Nuts
  • Crisps (not cheese and onion)
  • Oat cakes/ rice cakes/ crackers with dairy-free spread
  • Tea, coffee, squash, lactose free milk
  • Dark chocolate
  • Biscuits

Lactase enzymes

You can buy lactase enzymes from pharmacies, health food shops and online. They may reduce your symptoms if you do eat lactose by replacing the lactase that your gut does not make. There is not much research on how well they work.

Can I ever eat foods containing lactose?

Most people find that their symptoms get better after cutting out lactose for 4 weeks. If you have secondary lactose intolerance, it can take longer.

Once your symptoms get better, try to put some lactose back into your diet. Start with a very small amount and increase slowly. Most people can manage some lactose but everyone has a different limit.

  • You should start by trying foods that are lower in lactose such as hard cheese.
  • Try a small amount and increase it gradually until you find the level you can manage.
  • Then you can try foods that are higher in lactose, like milk.
  • Start with a splash of milk in your tea/coffee or on your cereal and build it up slowly.
  • When you start to get symptoms, you have found your limit.

What if symptoms don’t improve?

If you are lactose intolerant then your symptoms should get better when you take lactose out of your diet.

If you do not feel better, then you do not have lactose intolerance and you can start having lactose again. You can talk to your doctor or dietitian about what else could help your symptoms.

Risk of anaphylaxis (serious allergic reaction) when reintroducing lactose

If you have ‘atopy’ (eczema, asthma, other allergies, hay fever), there is a very small risk that you can develop an allergy to milk protein if you completely avoid it for a long time.

To avoid this risk you should try to keep some low lactose dairy products in your diet such as hard cheese.

Contact Nutrition & Dietetics

Kendon House
Kendon Way
Southmead Hospital
Bristol

Telephone:  0117 414 5428 or 0117 414 5429

We're introducing online letters for appointments

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PEG, PIGG and RIG

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This page will provide you with information about longer term feeding tubes. The page will tell you what to expect before, during and after your operation. 

A member of the medical team, your dietitian or your speech and language therapist can answer any further questions you may have.

What is a feeding tube?

A feeding tube is a small tube that passes through the skin into your stomach. This allows special liquid feed, water and medicines to be passed into the stomach. It can help to meet your dietary needs.

Illustration of feeding tube placement through the skin into the stomach.

The three different operations used in North Bristol Trust are:

  • Percutaneous Endoscopic Gastrostomy (PEG) – uses a flexible camera (endoscope) that passes into your stomach.
  • Per-oral Image Guided Gastrostomy (PIGG) – the tube is placed using x-ray.
  • Radiologically Inserted Gastrostomy (RIG) – the tube is placed using x-ray.

The most common tube is the PEG. You may have a RIG or PIGG tube if you cannot have sedation or if the camera cannot access your stomach.  We will discuss with you which type is best. 

Why do I need a feeding tube?

There are many reasons why you may need a feeding tube. We will discuss this fully with you. You may consider a feeding tube when:

  • You are losing weight.
  • You cannot eat or drink enough.
  • Eating and drinking leads to choking or discomfort.
  • Your breathing function is reduced or you get chest infections.
  • It takes a long time to eat and it is no longer enjoyable for you.
  • You have been getting nutrition through a tube in your nose for many weeks (nasogastric tube (NG)).
  • The feeding tube in your nose keeps coming out.
  • It is unsafe for you to eat or drink.

Sometimes feeding tubes are placed if you have problems with swallowing.

Will a feeding tube stop me eating and drinking?

Not always, but this will be discussed with your doctor or speech and language therapist.

The tube itself will not affect your ability to eat and drink. Some patients decide to still eat small amounts for pleasure. Some use the tube to provide extra nutrition on top of what they eat and drink.

What are my other choices if I decide against having one?

If you decide not to have a feeding tube, it is unlikely that there are any other ways to meet your dietary needs. You should discuss your choices with your doctor and dietitian.

If you decide against tube feeding you will be supported in this decision. Please make sure you know the risks you may be taking.

How do I prepare for a feeding tube?

All types of feeding tube are placed in hospital. 

If you are not already on a ward:

  • A few days before the operation you may have a blood test and a swab taken by the GP.
  • You may be asked to stop taking certain blood thinning medications for a few days before the operation. You may receive a phone call with more information before the operation.
  • You will need to come in on the day of the operation.

If you are an inpatient:

  • The ward team will advise you about stopping any blood thinning medications. They will also complete blood tests. 

Before the operation:

  • You will be asked to have no nutrition (food) for at least six hours before the operation. You will also be asked to have no fluids for two hours before the operation. You may be given medication through a drip.
  • The doctor will examine you, explain the operation and ask you to sign the consent form.

You will likely stay in hospital for at least a night for monitoring.

Are there any risks?

Most people will not have any serious issues from their tube placement. However, the risks of a complication increase with age. Your risk of having issues is also increased if you have from heart, chest, or other medical problems, such as diabetes, or are overweight, or smoke.

Major complications occur in around 3 in 100 people and include:

  • Breathing problems.
  • Heart complications.
  • Peritonitis (swelling in stomach wall).
  • Bleeding.
  • Bowel perforation (accidental tear in your gut).
  • Wound infection.
  • Fistula formation (two organs connect).
  • Leaking around the tube.
  • Tube blockage.
  • Buried bumper (stomach grows over part of the tube).
  • Over granulation (excess skin grows on the tube).
  • Infection.

There is a low mortality rate. To minimise complications, we will choose the technique that is safest for you. 

How is the tube placed?

If you are having a PEG

This is done in the Endoscopy Department. You will be given a local anaesthetic to your stomach, some throat spray, and light sedation (to make you feel relaxed). An endoscope (a flexible tube with a light and camera at one end) is passed down into your stomach and lit up.

A small cut is made in your stomach where the light shines and the tube is then passed through. The operation usually takes around 20 minutes.

You will be in the unit for some time before and after the operation.

This is what a PEG tube looks like: 

Photo of PEG tube.

If you are having a PIGG

This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach through the tube to make it visible on X-ray.

Local anaesthetic will numb your stomach. A small cut is made in your stomach and a wire is passed through to your mouth. The feeding tube is then passed through.

This operation typically takes 30 minutes.

This is what a PIGG tube looks like:

Photo of PIGG tube.

If you are having a RIG

This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach through the tube to make it visible on X-ray.

Local anaesthetic will numb your stomach and stitches are placed to hold the stomach close to the wall of the abdomen. A small cut is made near the stitches and a feeding tube is passed through into the stomach.

This operation typically takes 30 minutes.

This is what a RIG tube looks like:

RIG tube diagram

What happens afterwards?

  • Once back on the ward it be 4-24 hours before you can use the tube. The nursing staff will tell you when you can start to use the tube.
  • Water will be put through the tube first, followed by feed. Your dietitian will discuss the amounts and timings with you.
  • The nutrition given through the tube is a prescribed liquid mix of the nutrition your body needs. We call this “specialist feed”. The specialist feed, water, and medications can be put down the tube using a special syringe or pump.
  • You will need to sit upright during feeding and for 30-60 minutes afterwards.
  • The dietitians will provide training on how to give the feeds and water flushes. This will be done as soon as possible so that you can go home quickly. Either the nursing staff on the ward or the community feeding team can provide further training.

After your tube has been inserted there is an increased risk of complications. If you are going home within 72 hours after the tube is inserted, you will need to be aware of these.

If there is:

  • Leaking of fluid around the tube.
  • Pain on feeding.
  • Prolonged or severe pain after the operation.
  • New bleeding. 

Stop feed immediately

Phone your community feeding team or visit your local accident and emergency department for urgent advice

How do I look after my feeding tube? 

PEG / PIGG

1-5 days after insertion 

Once the tube is safe to use, you will begin to receive feed, medications, and water through the tube.

Flush the tube with water before and after you give the feed or medications to prevent the tube blocking

You should flush the tube with a minimum of 30mls of water every day if you are not giving nutrition or medications through the tube.

Clean the tube site (area where tube enters the skin) every with sterile water. Do this once or twice a day for the first 5 days.

After 5 days, use mild soapy water. Dry the area around the tube gently but thoroughly. Do not reposition the fixation device (triangle) unless advised.

Check for signs of pain, redness, swelling or leakage. Report any concerns to medical staff or the community feeding team.

The tube site doesn’t need a dressing after the first1-2 days. A simple gauze dressing can be used if there is leakage around the tube site.

2 weeks after insertion 

Continue to clean the tube site including around the fixation device with mild soapy water and dry well.

2 weeks after insertion, or when the tube site has healed, it is important to prevent the overgrowth of skin around the tube inside the stomach. We call this ‘buried bumper’ syndrome.

To prevent a ‘buried bumper’, the tube needs to be moved daily. This is called “advancing and rotating” the tube. The dietitian will show you how to do this before you leave hospital. The community feeding team will also demonstrate this.

To “advance and rotate” the tube: 
  1. Release the blue clip on the fixation device (triangle).
  2. Move the fixation device at least 4cm away from the stomach.
  3. With mild soapy water, clean both the tube site and the length of tube between the fixation device and stomach.
  4. Push 3-4cm of tube into the stomach.
  5. Turn the tube in a full circle (360 degrees).
  6. Pull the tube back until you feel some resistance.
  7. Wipe the tube clean.
  8. Place the fixation device approximately 5mm (pound coin width) from skin and close the blue clip. See Fig 6 and Fig 7 below.

This should only be done when the tube site is healed. 

RIG

1-7 days after insertion 

You shouldn’t eat or have anything via the tube for at least 4 hours after insertion.

You shouldn’t eat or have anything through the tube for at least 4 hours after insertion.

After this the tube will be flushed with 50ml of sterile water. If there are no concerns after 2-3 hours, then the tube is safe to use.

If there are signs of pain or leakage, let the nurse know.

You may have a dressing over the tube. The dressing should be changed every day for the first 7-10 days after insertion.

Clean the site every day with sterile water. You can lift the edges of the bolster (white circular disk) and clean underneath. Make sure the area around the tube is dried well.

Do not move the bolster for first 2 weeks after insertion.

Always check the marking where the bolster sits before putting anything through the tube. If there is a change in position of the tube do not use and contact the community feeding team immediately.

7-10 days after insertion 

Some people like to keep a simple dressing on the tube but it is no longer needed.

Continue to clean the tube site with sterile water and dry well.

2 weeks after insertion  

The stitches can be removed if they have not dissolved after 2 weeks. This can be done by the nutrition nurses.

The tube can be rotated daily once stoma tract has healed to prevent any overgrowth of skin. To do this, clean around the site with warm mild soapy water and dry well. Make sure you lift the edges of the bolster and clean underneath. Turn the tube in a full circle (360 degrees).

The water in the balloon should be changed 2 weeks after insertion and once a week after that. This is to make sure the balloon stays inflated to hold the tube in place.

In hospital, the ward dietitian or nurse will change the balloon water. You will be shown how to do this by the dietitian or community feeding team. When changing the balloon water, you can “advance and rotate” the tube at the same time. This helps prevents any overgrowth of skin on or around the tube.

To “advance and rotate” the tube:
  1. Make note of the mark on the tube where the bolster sits.
  2. Gently move the bolster away from the skin surface by at least 4cm.
  3. With mild soapy water, clean both the tube site and the length of tube between the bolster and stomach.
  4. Push 3-4cm of tube into the stomach.
  5. Turn the tube in a full circle (360 degrees).
  6. Pull the tube back until you feel some resistance.
  7. Wipe the tube clean.
  8. Place the bolster back to the original position approximately 5mm (pound coin width) from skin.

The tube needs to be changed around 3 months after insertion. This is usually done where you live by the community feeding team.

Further tube changes will usually be done every 3-6 months. If you wish, you or your carers can be trained to change the tube yourselves.

What help is available once I leave hospital?

Your ward dietitian will refer you to the community feeding team or an alternative service in your area. The community feeding team are known as the home management services (HMS).

The team comprises of dietitians, home enteral feeding nurses and a delivery company. They will contact you to arrange a monthly delivery of feeds and plastic equipment, such as syringes.

We may send you home from hospital with a small supply of feeds and equipment.

Your ward dietitian will explain your home feeding plan and provide contact details for the HMS team. Your GP may also be involved in the management of your tube.

What do I do if the tube becomes blocked?

Medicines can block the tube if they are not given correctly. You may need to be prescribed medicines in a more suitable form such as liquid. Your doctor or pharmacist should arrange this for you. Each medication should be given individually.

To help prevent tube blockage, we advise you do not give anything other than the feeds, water, and medications through your tube.

If you are unable to flush the tube or can see a blockage you should:

  1. Ensure all clamps are open and the tube is not bent.
  2. Massage the tube to try to dissolve any blockages.
  3. Flush with 50ml warm or soda water, leave for 30mins and re-flush. Never use pineapple juice, cola or lemonade as they can make the blockage worse.
  4. Try the ‘push/pull’ action with a syringe as advised by nursing staff.
  5. Contact community feeding team or call the 24 hour helpline on your feeding regimen.

Note: For a RIG tube, only trial these methods if the tube can be advanced and rotated. Otherwise, contact your community feeding team. 

How long will I need the tube?

The tube can be removed if you no longer need it or want it removed. If well cared for can last several years.

The RIG tube will be changed every 3-6 months.

What if the tube is accidentally removed? 
 

For PEG/PIGG tube

If the tube comes out you will need to go to your nearest accident and emergency department immediately. The longer the tube is out, the greater the risk of the site closing over.

For RIG tube

If your RIG tube comes out, ring the community feeding team or 24 hour helpline. You may need to go to your nearest accident and emergency department to have another tube inserted.

The community enteral feeding nurses may have trained you to insert a device into the stoma called Corstop ACE stopper or ENPlugs.

In the case of the tube coming out, you can insert this device. Then call the community feeding team or 24 hour helpline for further advice.

Common questions

Can I shower/bath? 

You can shower from the day after the tube has been placed. Do not have a bath for at least 4 weeks until the area around the tube has healed. Make sure the end is closed and clamp applied before washing. Fully dry the area around the tube after.

Can I swim?

Only once the area around the tube has healed. Use a waterproof dressing. Fully dry the area around the tube after.

Can I go on holiday?

The tube does not stop you going on holiday. You may need to take a GP letter and insurance documents with you. Contact the home feeding team for further information.

Will I be able to move freely?

The tube should not restrict your everyday activities. You can cover the tube with loose clothing.

What happens if I become unwell?

If you feel unwell and are unable to give yourself your feed, it is important to keep hydrated. Flush the tube regularly with water to prevent the tube blocking and to keep hydrated. Speak to your GP, nurse or dietitian if you are concerned.

How do I keep my mouth clean?

You will need to keep your mouth and teeth clean by brushing regularly. This is important even if you cannot eat and drink. A mouthwash and artificial saliva spray may help to keep your mouth moist. The speech and language therapist can guide you on this.

Who pays for the feeds?

If you are an NHS patient and registered with a GP, your local health authority will pay for the feeds.

What do I do if I experience any pain, discomfort or issues with my tube site? 

If you experience any pain or discomfort then stop any feed. Contact the community feeding team for further advice. Contact the community feeding team if the skin around the site becomes red and sore or if there is oozing or bleeding.

Further information

Nutricia website provides information on specialist feed and using a feeding pump. There is also information on the nursing team who help people with feeding tubes: 

PINNT helps people on enteral and parenteral nutrition providing advice and local help groups.

References

  • Arvanitakis, M., Gkolfakis, P., Despott, E., Ballarin, A., Beyna, T., Boeykens, K., Elbe, P., Gisbertz, I., Hoyois, A., Mosteanu, O., Sanders, D., Schmidt, P., Schneider, S. and van Hooft, J., 2020. Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 53(01), pp.81-92.
  • Gkolfakis, P., Arvanitakis, M., Despott, E., Ballarin, A., Beyna, T., Boeykens, K., Elbe, P., Gisbertz, I., Hoyois, A., Mosteanu, O., Sanders, D., Schmidt, P., Schneider, S. and van Hooft, J., 2020. Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 53(02), pp.178-195.
  • Nutricia Homeward (2021) Balloon Gastrostomy Tube Advice.
  • Potack, Z. and Chokhavatia, S., 2008. Complications and controversies associated with Percutaneous Endoscopic Gastronomy. Report of a Case and Literature Review. The Medscape Journal of Medicine, 10(6), pp. 142.
  • Toussaint, E., Van Gossum, A., Ballarin, A. and Arvanitakis, M., 2015. Enteral access in adults. Clinical Nutrition, 34(3),pp. 350-358.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002346. 

Cancer Nutrition Leaflets

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Forms, Booklets and Leaflets

You can get physical copies of these booklets and leaflets from the Macmillan Wellbeing Centre based at Southmead Hospital. Please come and visit.

Referral Forms:

Self-referral form

Professional referral form 

 

Eating well:

Healthy Eating and Cancer – Macmillan Healthy eating and cancer

Healthy Eating – British Dietetic Association Healthy eating 

Healthy Snacks – British Dietetic Association Healthy snacks

 

Difficulty with eating:

Eating Problems and Cancer – Macmillan Eating problems and cancer

Building Up Diet – Macmillan The build up diet

 

Weight management after cancer treatment:

Managing Weight Gain After Cancer Treatment – Macmillan  Managing weight gain

Weight loss - British Dietetic Association  Weight loss advice

Portion sizes - British Dietetic Association Portion sizes

Newborn Screening FAQ's

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Has the sample I sent recently arrived in the lab yet? How can I check?

The Northgate Failsafe system is updated in the morning of each working day. If the sample has arrived and been booked in it will show on the failsafe as pending. Please bear in mind that sometimes the post is slow, especially around bank holidays. If you don’t have access to the failsafe system, then contact your local screening coordinator in the first instance. We receive a high volume of calls which directly impacts on the speed we can open post and book in and process samples.

We are happy to receive phone calls if you, a colleague or the screening coordinator have checked the failsafe already and the sample isn’t showing and the sample was posted at least 5 days ago.

Why has the sample I collected been rejected?

When samples that are unsuitable for testing arrive, we record the reason for rejection. This information is given to the midwifery team / screening coordinator when we contact them to organise for the repeat to be collected.
The reason will also be shown on the Northgate failsafe system.
Further details including common reasons for sample rejection, tips and learning resources can be found on our ‘Repeat samples and Limitations of testing’ page.

Once you are aware of the reason for rejection and would find it helpful to see a picture of the sample you collected for educational purposes, please email us.

When will the results be available

The aim is for all babies suspected of having any of the screened conditions, to be seen by the appropriate clinical team and treatment started in a timely manner. The child health record departments (CHRDs) keep track of which babies have been screened. Ideally, the lab should provide the CHRD with results by 17 days of age (for all babies with normal results for all 9 conditions).

Parents with a not suspected result for each of the conditions should have a not suspected results letter sent directly to them by the CHRD within 6 weeks of birth.  They will be contacted sooner if there is thought to be any problem with their baby.

General timescales:
The first blood spot sample should be taken at 5 days of age, and national standards state it should arrive in the lab within 3 working days. Samples are booked into the laboratory computer system on the day of receipt and appear as pending on the Northgate failsafe system on the morning of the next working day. Samples are tested for all 9 conditions either the day of receipt or the following day.

Babies with positive results, suspected of having PKU, MCADD, MSUD, IVA, GA1 or CHT (on the first sample), are referred to the appropriate clinical team within 3 working days of the sample arriving in the laboratory. Testing for CF or SCD can sometimes take a little longer and for a small number of babies the screening pathway for CF and CHT requires a second sample (‘unavoidable repeat’) to be taken before a not suspected, suspected or carrier result can be reported.

Occasionally results may be delayed. Most commonly these are due to post / transport delays, especially around bank holidays, or samples arriving which are unsuitable for testing causing the need for an ‘avoidable repeat’.
Very occasionally we have technical problems such as analyser breakdowns or IT issues which may cause a delay, however, we have a number of contingencies in place to ensure the correct results are reported in a timely manner.

When does the failsafe get updated?

Data is extracted from our lab computer system automatically every night at about 11pm for upload on the morning of the next working day. Unfortunately it is not possible to change the time of this extract on demand.

Who do I contact for advice?

Our Key contacts are listed here.

Can I arrange a visit to the laboratory?

We offer half-day training sessions to midwives, health visitors, dieticians, nurses, doctors and other healthcare professionals involved in the collection of bloodspots.  Please email nbn-tr.newbornscreening@nhs.net in the first instance.

Will the test show if a baby is a Cystic Fibrosis (CF) carrier?

Approximately 1 in every 25 people in the general population is a CF carrier. Our testing strategy will not detect all babies who carry the CF gene, but as part of the testing for cystic fibrosis a few carriers are identified (approx. 12-15 babies /year in the South-West region).
When this happens, information is given to the family, usually by the health visitor, as the family may wish to seek genetic counselling, especially if they are planning future pregnancies.

Will the test show if a baby is a sickle cell carrier?

Yes, the test will show if a baby is a sickle cell carrier, or a carrier of another clinically significant abnormal haemoglobin variant.

For further advice regarding the sickle cell screening programme please contact the Lead Biomedical Scientist in Haematology.

Will the test show if a baby has thalassaemia?

Some cases of thalassaemia will be detected and some not. Carriers are unlikely to be identified at this age. 

For further advice regarding the sickle cell screening programme please contact the Lead Biomedical Scientist in Haematology.

When did the Bristol Newborn Screening Laboratory start testing babies in the South West for each of the nine conditions?

Condition

Date

PKU

late 1960's

CHT

early 1980's

Sickle / Haemoglobinopathies

2005

CF

2007

MCADD

2008

Expanded screening for IMDs (GA1, IVA, HCU, MSUD)

January 2015

Health professionals:  If you would like to confirm that a child has been screened for a particular condition, please contact us. Please remember that not all children currently living in the South West will have been screened for all the conditions offered at the time of birth, as some may have been born in another area/country, or the parents may not have consented to a sample being collected/tested.

Contact Newborn Screening

Newborn Screening Laboratory (Bristol)
PO Box 407
Bristol
BS9 0EA

Email: newbornscreening@nbt.nhs.uk
Telephone: 0117 414 8412
 

Opening times: 9am - 5pm Monday - Friday excluding bank holidays.

Clinical advice & interpretation is available during working hours.

Access the NHS Blood Spot Screening Programme Centre

Test Information

Sample vials for testing

Includes details of sample types, volumes, special precautions, turnaround times & reference ranges.

Carer Support Scheme - A guide for carers

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North Bristol NHS Trust is committed to making reasonable adjustments to support patients and carers whilst they are in hospital and to work in partnership with them.

Carer contributions are greatly valued. To help you to give ongoing support and care to your loved one whilst they are in hospital we have a Carers Support Scheme. The Scheme provides complimentary parking, an access card to the staff restaurant and referral to our Carers Liaison Service.

Complimentary parking and restaurant access card

Eligibility

The carer spends a minimum of three hours per day or the equivalent of 20 hours or more over a seven day period on the ward providing support to the patient.

This support could include:

  • Personal care - providing assistance with washing/dressing.
  • Oral hygiene/mouthcare - teeth brushing/cleaning dentures.
  • Assisting with eating and drinking.
  • Providing support at the end of life.
  • Helping to reduce patient anxiety or behaviour which indicates that the patient is anxious or distressed.
  • Providing reassurance to the patient when difficult or painful procedures need to be performed, including accompanying the patient to the theatre and being present in recovery after the operation.
  • Providing assistance if the patient is uncooperative, for example if physiotherapy is considered to be necessary to aid the patient’s recovery.
  • Helping to prevent the patient falling.
  • Providing other forms of support as agreed between the carer/parents/ward staff or registered practitioner.

Carers who are eligible can receive:

  • Complimentary car parking for up to two weeks (this can be renewed when requested by staff).
  • Access to the staff restaurant for meals.
  • Support to stay overnight which, depending on availability, may be a reclining chair or bed.
  • Referral to the Carers Liaison Support Service.

Senior members of staff should be consulted when applying for a carer to access a car parking permit or restaurant access card, but any member of staff can support a carer to complete the form.

Carers will be given an information leaflet about the Carers Support Scheme to read to make them aware of the terms and their accountability under the agreement.

Complimentary parking

  • A complimentary car parking permit is valid for all public car parks on the Southmead Hospital Site.
  • Carers must visit the Security and Parking office to collect their permit where their car registration will be added to the system. Car park barriers will open and a parking ticket will be issued for use in the pay and display car parks.
  • The car parking permit is valid for up to two weeks. Permits can be renewed multiple times up to the end of a hospital stay. Ward staff will need to complete a new form each time it is renewed.

Please note that two carers’ registration numbers will be allocated to one permit/per patient.

If you wish to exchange a registration number for another please take the slip issued by the Security and Parking Office who will then update your details. If circumstances change you will not automatically be guaranteed a new permit.

Important information for Blue Badge holders

This badge can only be used by the named badge holder, or by a person who has dropped off or is collecting the badge holder from the place where the vehicle is parked. It is a criminal offence for anyone else to use this badge in any other circumstances.

Access to the staff restaurant

Carers Cards

  • Carers can obtain a Carers Card from the Security and Parking office. A £5 deposit is required and will be fully refunded when the card is returned.
  • The Carers Card will allow access to the staff restaurant (you will be given a separate map when you pick up the card) to purchase a hot meal and drink at advertised prices. Meals and drinks are not discounted or free; cards only provide access to the Vu restaurant.
  • To use the card, hold it up near the grey boxes at the side of the door. There should be a beep and the light will change to green. You can now open the door. Try again if you get multiple beeps or a red light.
  • Carers Cards are valid for up to two weeks and can be renewed multiple times up to the end of the hospital stay. The ward will need to complete a new form each time it is renewed.
  • All Carers Cards must be returned to the Security and Parking Office upon discharge where the £5 deposit will be fully refunded.
  • All Carers Cards will be cancelled after seven days if not being used.

Please note the Security and Parking Office is open 7am – 6.30pm, Monday to Friday. If a patient’s expected discharge date is outside of office hours please return the card before the office closes at 6.30pm explaining the situation.

Card usage rules

  • Cards do not provide access to any wards.
  • Access to the staff restaurant from the Atrium is through one specified door (see map).
  • Only one card will be issued per patient (cards can be shared if more than one person is providing care that fits the eligibility above).
  • Only two carers are permitted per restaurant visit (if sharing cards as above).
  • Patients are not permitted in the staff restaurant.
  • Cards must not be passed to other hospital visitors; it is only valid for the carer it is issued to and must not be kept on the wards.
  • Meals are not discounted or free - cards only allow access to the restaurant.
  • If you are found to have abused any of the above, cards will be withdrawn.
  • Cards must be returned to the Security and Parking Office at the end of hospital stay when the £5 deposit will be refunded.

Cards can be withdrawn should the criteria not be fully adhered to.

If you have any questions or concerns regarding the Carers Support Scheme, please speak to staff on the ward or at the Security and Parking Office.

Carer Support Services

There are a number of different carer support organisations across the country who can provide information, support and signposting for unpaid carers. These organisations can make sure you are linked into services providing financial, practical and emotional support for your role.

To find your local carers support service contact your county council or go to the Carers Trust website at https://carers.org/ and use the search feature to find your local centre.

Support for Carers in Bristol and South Gloucestershire

Carer liaison workers are based at Southmead hospital. We work with carers supporting someone living in Bristol and South Gloucestershire.

We can:

  • Provide help, information, and advice to carers through their hospital journey as a carer and/or patient, working directly on wards and signposting to other services for support.
  • Refer carers for ongoing community support upon discharge.
  • Provide information on services available to carers within the hospital and the wider community.
  • Liaise between the discharge team, ward staff and carers and their family, to help with any concerns or worries.

How to contact us 

Telephone: 07557 418692

Email: carersliaison@nbt.nhs.uk

© North Bristol NHS Trust. This edition published February 2023. Review due February 2026. NBT003195

Do you have a small appetite?

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Appetite and health

Having a good appetite is important to make sure your body gets all the nutrients it needs to stay healthy.

As you get older or become unwell, your appetite can disappear.

This page offers tips to help you eat better.

Some of the information may be different to typical ‘healthy eating’. However, when you are ill healthy eating may be harmful for your health.

Once you are well or a healthy weight you can return to healthy eating.

Possible side effects of having a small appetite

  • Higher risk of infection
  • Higher risk of falls
  • Lower mood
  • Lower energy levels
  • Loss of muscle and reduced strength
  • Nutrient deficiencies
  • Hospital treatment may be less effective
  • More hospital admissions and longer hospital stays

Tips for eating better with a small appetite

  • Eat ‘little and often’.
  • Have 2-3 small snacks or milky drinks in between meals.
  • Try not to skip meals. Skipping meals often can cause low appetite.
  • Choose full fat/full sugar versions of food/drink rather than the ‘diet’ alternatives.
  • Try to eat more on the days and times you feel well.
  • Aim to have 1 pint of milk a day. This can be in tea, coffee or milkshakes.
  • If following a plant based diet, try and include alternative milky drinks and puddings (e.g soya, oat milks etc).
  • Have a pudding after meals.
  • Eat in a peaceful environment. You may find turning on the TV or eating with friends and family helpful.
  • If cooking/shopping is too much, consider meals on wheels e.g. Wiltshire Farm Foods, Oakhouse or Cook.
  • If you have access to the internet you may also find home delivery helpful. Age UK and Red Cross can help with shopping.

Which foods should I snack on?

Foods with lots of energy and protein are a good source of fuel. They also help fight infection.

High protein foods include:

  • Meat, fish, poultry
  • Cheese, milk, eggs
  • Tofu, beans, lentils
  • Yoghurt, cream and milky puddings
  • Nuts and seeds
  • Milky drinks e.g. hot chocolate, ovaltine
  • Fortified drinks and food
  • If on a plant based diet - dairy free milks and puddings

High energy foods include:

  • Biscuits
  • Crisps
  • Cakes
  • Chocolate
  • Puddings
  • Cream
  • Butter
  • Fruit juice and smoothies

Choose full-fat versions of these foods whilst you are unwell.

Snack ideas

Aim for 2-3 snacks every day.

Savoury

  • “Cream of” soups - have 1 x tin or 1/2 tin with croutons
  • Handful of Bombay mix or nuts
  • Matchbox size portion of cheese and crackers
  • 1x bag of crisps
  • Slice of quiche
  • 3 x cocktail sausages
  • 2 x mini sausage rolls
  • 1 x small pork pie
  • 1 x slice of toast with butter
  • 1 x crumpet or bagel with butter

Sweet

  • 1 x slice toast with butter and jam/marmite/peanut butter/chocolate spread
  • Scone with jam and cream
  • Rice pudding
  • Cereal bar
  • 1 x tea cake
  • 1 x slice malt loaf
  • Individual puddings e.g. trifle, custard, cheesecake, mousse
  • 1 x bar of chocolate
  • Full fat yoghurt
  • 1 x handful of dried fruit
  • 1-2 x scoop of ice cream

Nourishing drinks

If you struggle to have extra snacks try to have 1-2 nourishing drinks instead.

Aim to have 1 pint of milk a day. Use in cereal, tea, coffee and other nourishing drinks listed below.

  • Full cream milk (aim for 1 pint per day)
  • Milkshakes
  • Hot chocolate
  • Malted drinks
  • Milky coffee and tea
  • Smoothies
  • Sugary fizzy drinks e.g. lucozade, cola
  • Fruit juice
  • Soya drinks e.g. Provamel, Alpro Soya

Fortifying foods

This can be helpful to make food more nourishing, without having to eat a larger portion.

Fortified milk

  • Whisk 4 heaped tablespoons of milk powder (e.g. Marvel or supermarket own brand) into 1 pint full fat milk.
  • Use this fortified milk in cereal, porridge, milky drinks, tea/coffee, puddings, soups and sauces.

Fortified mashed potato

  • Add 1 x heaped tablespoon of butter and 1 x tablespoon of cheese to a scoop of mashed potato.
  • Use fortified milk.

Fortified yoghurt/custard/milk pudding

  • Add 1 x heaped tablespoon of milk powder to one serving of yoghurt/custard/milk pudding.
  • Add toppings such as jam, syrup, honey, seeds or fruit.

Fortified sandwiches

  • Use spreads (e.g butter/margarine) generously.
  • Use lots of mayonnaise or salad cream.
  • Choose nutritious fillings such as peanut butter, egg mayonnaise, ham, tuna or cheese.

Fortified soups

  • Add cream, fortified milk, evaporated milk, creme fraiche, cheese or cooked meat.
  • Have croutons or bread.
  • Choose creamy varieties e.g. cream of tomato.
  • If using cuppa soups, make with fortified milk.

Fortified sauces

  • Use enriched milk to make white, cheese or packet sauces.
  • Add meat juice to gravy.
  • Add grated cheese, oil or 1 x teaspoon milk powder to one serving of tomato based sauces.

Fortified vegetables and salads

  • Try frying or roasting vegetables instead of boiling/steaming.
  • Add butter or grated cheese to vegetables.
  • Have cheesy or creamy sauces with vegetables.
  • Add cheese, nuts, eggs, beans, tofu or lentils to salads.
  • Use generous helpings of oil/creamy dressing and croutons/potatoes.

What about diabetes?

If you have diabetes and a poor appetite it may not be helpful to follow the usual ‘low fat, low sugar’ healthy eating advice.

However, once your appetite has returned to normal, you can return to healthy eating.

Meal ideas

Breakfast

  • Creamy scrambled egg with buttered toast
  • Porridge/cereals with honey/sugar
  • Crumpets with butter and jam
  • Muesli with whole cream milk and natural yoghurt

Lunch/lighter meals

  • Beans on buttered toast with grated cheese topping
  • A buttered jacket potato with tuna mayonnaise filling.
  • Ham or cheese omelette, chips and salad with mayonnaise
  • A creamy soup with added grated cheese and croutons

Main meals

  • Shepherd’s pie with grated cheese topping and vegetables with added margarine or butter
  • Chicken curry or dahl with rice or chapatti spread with oil, butter or margarine
  • Cauliflower cheese made with fortified milk with grated cheese topping
  • Fish in cheese sauce with creamed potatoes and vegetables with added margarine or butter

Puddings

  • Milk pudding e.g. rice/tapioca/semolina
  • Baked egg custard
  • Crumble with ice cream
  • Trifle with cream
  • Jelly made with fortified milk

Nutritional supplements

Some people may be prescribed nutritional supplements from their doctor or dietitian.

Supplements are drinks that are high in energy and protein and can be helpful for some people whilst unwell. They are available on prescription. Your doctor or dietitian will discuss these with you if they think you may need them.

You can buy other supplements such as Complan or Meritene from local chemists. You may find these helpful if you cannot make nourishing drinks at home.

Where now?

For further information you may find the following resources useful.

Brotherton et.al (2010). ‘Malnutrition Matters: Meeting Quality Standards in nutritional Care.’ A report on behalf of the BAPEN Quality Group

Diabetes UK

www.diabetes.org.uk

Cook Food - freezer meals with delivery service

www.cookfood.net

Parsleybox - cupboard meals with delivery service

www.parsleybox.com

Wiltshire Farm Foods

www.wiltshirefarmfoods.com

Oakhouse Foods

www.oakhousefoods.co.uk

Eating well in later life - Malnutrition Task Force

www.malnutritiontaskforce.org.uk/eating-well

Food enrichment - BAPEN

www.bapen.org.uk/nutrition-support/nutrition-by-mouth/food-first-food-enrichment

Malnutrition fact sheet - British Dietetic Association

www.bda.uk.com/resourceDetail/printPdf/?resource=malnutrition

The Red Cross - offering help with shopping

www.redcross.org.uk

AgeUK - offering help with shopping

www.ageuk.org.uk

How to contact us 

Dietetic Department: 0117 414 5248

© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT002833

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery
charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

FIT Testing for Clinicians

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Information for GP's

The implementation of the Faecal Immunochemical Test (qFIT) testing for occult blood for the detection of colorectal cancer in patients in the SWAG cancer alliance area

Individual CCGs (Gloucester, BNSSG, BSW and Somerset) within the SWAG Cancer Alliance have funded FIT testing for the early detection of colorectal cancer.  Originally this was for low risk patients but indications have been expanded and updated. 

For further information on the requesting indications, process and reporting guidelines please refer to the relevant page on the REMEDY website: https://remedy.bnssg.icb.nhs.uk/adults/gastroenterology-and-colorectal-surgery/fit-test/

Information about qFIT testing is presented in this video made when the service was first introduced. Although some of the indications have been expanded the essence of the video is still applicable https://youtu.be/zb1o8ykvS6U

Test Information

Sample vials for testing

Includes details of sample types, volumes, special precautions, turnaround times & reference ranges.

FIT Testing for Clinicians